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Wednesday, October 19, 2011

The Morning Drill: October 19, 2011

Healthcare reform funding will double the number of federally qualified health centers (FQHCs) in the U.S. and create new opportunities for dentists young and old, according to a panel discussion last week at the ADA annual session in Las Vegas.

In addition to providing care for the underserved, FQHCs also supply valuable training for dental students and a "second home" for many retired dentists, the panel members noted.

More than 19 million people received medical treatment at the 1,200 federally qualified health centers (FQHCs) in the U.S. last year. Approximately 75% of the centers now have dental clinics, which provided dental care to 3.7 million people in 2010.

And the Affordable Care Act includes $11 billion to create twice as many clinics over the next 10 years, but the amount keeps getting cut during ongoing budget negotiations.

Most patients are children, Medicaid patients, minimum wage workers, and families with no dental insurance.

Skip Homicz, DDS, a dentist from Portsmouth, NH, was coaxed out of retirement to become the dental director of the Families First Health and Support Center. He was one of four medical professionals, including three dentists, who told a crowded room what it's like to go from a private practice treating patients who usually had insurance or could pay, to doing extractions and fitting dentures for the poor and homeless who pour into the Portsmouth clinic.

The main problem, Dr. Homicz noted, is dealing with the "black abyss": those over 19 years old who need complicated treatments. "That's where we're seeing people who haven't been to the dentist in 10 years," he said. "I've got to tell you, we're not doing a lot of root canals. The resources aren't there to do full crowns. We do a lot more exodontia, removable bridge work. We do a lot more dentures. We take a lot of people out of pain and take care of a lot of infections."

Dentists could use their professional and managerial skills to help run dental centers and mentor dental students and new graduates, Dr. Homicz said. He stressed the importance of being under one roof with physicians with whom he can consult before treating patients with chronic conditions such as high blood pressure.

The speakers encouraged those attending to contact their state or local dental association to volunteer at FQHCs or join the boards that oversee them. Retired dentists who have run their own practices can provide crucial input and put their experience to use, they noted.

Eradicating malaria is not a vague, unrealistic aspiration but a tough, ambitious goal that can be reached within the next few decades, the billionaire philanthropist Bill Gates said on Tuesday.In an interview with Reuters at his Gates Foundation's Malaria Forum in Seattle, the Microsoft founder who now spends his time and money on global health and development projects rejected skepticism about focusing his aim on wiping out the killer mosquito-borne disease worldwide.

"It's not a near-term goal," Gates said, but one that can "certainly" be achieved within his lifetime.

"I'd be disappointed if within 20 years we're not very close to eradicating this globally," he said.

Malaria currently kills about 780,000 people a year -- the vast majority of them children and babies in sub-Saharan Africa -- and is endemic in about 100 countries.

Gates said a renewed focus and substantial increases in funding for malaria, partly spurred by his call in 2007 for global eradication of the disease, was steadily "shrinking the malaria map" and would continue to do so.

He pointed to Madagascar, Papua New Guinea and Ethiopia as "likely early candidates" for being able to eliminate the disease from within their borders in the near future.

Giving a boost to anti-malaria efforts was news on Tuesday of an experimental vaccine from GlaxoSmithKline that halved the risk of African children getting malaria.

However experts stressed the vaccine was no quick fix for eradicating malaria. The new shot is less effective against the disease than other vaccines are against common infections such as polio and measles.

Gates' eradication call in 2007 -- the first time the "e-word" was revived since a global malaria eradication push launched in 1955 faltered and failed -- was seen by some experts in the field as an unwelcome and fanciful notion.

A Coralville dentist has been given four years of probation by the Iowa Dental Board for charges related to performing unnecessary dental work and fraudulent billing practices.

However, Dr. John R. Strief said Tuesday he does not agree with the charges.

“We work very hard to provide our patients with the best care possible,” he said. “I think our patients will know these charges are not correct.”

The dental board filed a six-count statement of charges against John R. Strief in April. The board accused Strief of unprofessional conduct by submitting an insurance claim to a third party reporting incorrect treatment dates, obtaining a fee by fraud or misrepresentation, unprofessional conduct by performing unnecessary dental services or procedures, failure to maintain a “reasonably satisfactory” standard of competency, willfully or repeatedly violating board rules by failing to maintain proper records and willfully or repeatedly billing patients for services he did not provide.

According to the statement of charges, the board launched an investigation into Strief in March after a complaint. The board obtained numerous patient records, which were reviewed by consultants. The consultants determined Strief was not “practicing to an acceptable standard of care,” according to dental board documents.

The board found that Strief regularly submitted multiple insurance forms in which he misrepresented the dates of service to receive payment.

Strief was given a chance to respond in writing to the board’s allegations; however, his records contained “little or no evidence” supporting the treatment he provided, according to the board.

Strief said the investigation was the result of a single complaint lodged by a former employee, who he described as “very disturbed” and disgruntled.”

However, Strief said he agreed that the charges were “very serious.” He said they stemmed from omissions in patient records or errors in claim forms from 11 patients, which he said gave the appearance that patients were charged for work that was not done.

Under the terms of his probation, Strief has agreed to repair or replace any of the unnecessary work he performed within the next five years. Strief has been given 30 days to submit a practice monitoring plan to review his clinical and billing practices. He also was ordered to complete a record-keeping course and the Professional/Problem-Based Ethics Program.

Additionally, Strief has been ordered to pay a $10,000 civil penalty to the board within the next seven months.

California’s health program for the needy is approaching the state’s clinics with a controversial request: Send back those checks for root canals, tooth extractions and other dental services rendered within the last year.

State coverage for Medi-Cal patient dental and podiatry services was cut amid budget shortfalls in mid-2009, but reinstated by court order after clinics sued in October of last year.

Clinics offered the services again until May, when the state met the procedural hurdle to eliminate state coverage of benefits such as dental care and podiatry, which are considered optional under the state and federal Medicaid program.

Now, leaders of clinics are bracing for bills in the hundreds of thousands of dollars as the Department of Health Care Services says it wants its money back.

“We can’t take money from a dentist’s paycheck, take dental supplies back or get part of our light bill back,” said Jennette Lawrence Shea, director of government and community relations for Family Health Centers of San Diego. “It puts all of the burden on community clinics, and that’s just not right. We’re the safety net, here to help the most vulnerable. We’re struggling to do that with all of these cuts.”

Lawrence Shea said the clinic provided 5,300 dental visits from October to May at sites throughout San Diego County and expects to be on the hook for about $850,000.

Norman Williams, spokesman for the Department of Health Care Services, said in an e-mail that providers were warned during the court-order period that they may have to send back the money.

“We have a responsibility to protect the fiscal integrity of the Medi-Cal program," Williams said.

Williams did not have an estimate for the total amount owed to the state or how many clinics would be expected to send refunds. The state has issued an advisory letter on the matter but hasn't started billing individual clinics yet.

The effects are expected to be felt statewide.

Marty Lynch, executive director of LifeLong Medical Care in Berkeley, said his organization provides a range of care to about 23,000 low-income and homeless adults each year. He estimates the organization will owe about $400,000 worth of dental services.